INTRODUCTION
HOW TO DECREASE HEALTHCARE COSTS
The US Healthcare system is in crisis right now. Despite having the most expensive healthcare in the world, we are sorely lacking in most measures of health outcomes compared to most major industrialized nations such as Canada, the UK, Germany, France, Japan, South Korea, etc. Life expectancy for both males and females are 4-5 years less than comparable countries. The US has the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality rates and we have one of the highest suicide rates. We have the highest rate of people with multiple chronic conditions such as Diabetes, heart failure, COPD, hypertension, coronary artery disease, and an obesity rate nearly twice that of comparable countries. We see physicians less often than people in other countries and have the lowest rate of practicing physicians and hospital beds per 1000 population. We also have the lowest rate of primary care physicians to specialists’ ratios.
In addition, there are huge inequities within our healthcare system. Your zip code can tell a lot about your life expectancy and access to healthcare. This should not happen in one of the richest countries in the world.
Why is out healthcare system in such a mess you might ask. In my opinion there is absolutely no leadership. There is no one truly in charge. Medicare and insurance companies are basically clueless. They are run mostly by bureaucrats and do not take input from practicing physicians who are in the trenches. They preach about certain goals such as improving quality, but incentivize so that opposing goals like seeing more patients are rewarded. They talk about rewarding primary care because that is what most other successful countries base their healthcare systems on and primary care physicians are best able to co-ordinate care for patients, but they reward specialty care and diminish the role of primary care doctors such that most new doctors for years have gone into specialty care. Our country is a specialty-based health care system at the expense of primary care, and that is why it is so expensive and inefficient.
Our healthcare system is also run by lobbyists and political action committees. They, in effect, influence congress and tilt the table towards rewarding hospitals, medical supply companies and big pharma, all to the detriment of patients and the doctors trying to take care of them. Why do we pay 2-3 times the cost for the same drugs as Canadiens or Europeans? Insulin, which has been made longer acting and shorter acting, but basically has not changed in 100 years has increased its costs 600% in the past 20 years. In all other industries, technology decreases cost. In healthcare, it increases costs consistently. Why have the number of bureaucrats it takes to run a hospital more than quadrupled in the last 40 years? The answer is because of all the red tape Medicare and insurance companies throw at them.
So why am I writing this series? As I stated, our healthcare system is in shambles. It is a crisis management system. In other words, Medicare and insurers pay a doctor to treat you when you are sick, but they don’t pay to keep you healthy in the first place. My goal is to help you to navigate the healthcare system so you can take advantage of what is useful and hopefully avoid the excess of the system.
How can you best navigate the healthcare system? The first thing I would recommend is to get yourself a primary care physician, either a general internist or a family physician. Millions of people in American don’t have a primary care physician. There are many reasons for this. There is a physician shortage, which affects primary care doctors worse because of current methods of reimbursing physicians. In addition, many people don’t have insurance coverage, or have coverage that is inadequate so they cannot afford to see a doctor. The result of so many people not having a primary care physician is fragmented care. People do not get routine preventive care. They go to urgent care or emergency rooms when sick, where the caregivers do not know them or their history. People without a primary care physician also use specialists more often which again can lead to fragmented care due to lack of communication and co-ordination.
A good primary care physician will review specialists notes and co-ordinate care, reconcile medications so conflicting medications are not given by different doctors. In addition, in many cases, if you are only seeing your specialist once a year for follow-up, your primary care physician can often do that care, saving you a doctor’s visit and copays.
In addition, I will be discussing ways to keep yourself healthy. That is by far the best way to lower your health care costs. People often don’t want to hear it, but exercise and healthy eating are the best medicines.
I am going to steal an idea from my good friend and colleague Dr Snehal Gandi. He shows in graph form where our current medical dollars go.
Prevention $. Chronic care $$$$$ Complications $$$$$$
Under a more reasonable healthcare system, the spending would go like this:
Prevention $$$$$. Chronic care $$ Complications. $$
Most of the spending would go to keeping people healthy. If that goal is achieved, there will be less need to spend on chronic care, and the complications that go along with chronic care.
For instance, if more attention were paid to high blood pressure and treating it to goal, there would be less heart disease needing treatment. Less heart disease leads to less complications like heart attacks and heart failure.
Better diets and lifestyle habits would lead to less obesity. Less obesity would result in a lower rate of type two diabetes. Less type two diabetes would result in less diabetic neuropathy, less diabetic peripheral vascular disease, less diabetic kidney disease, and less diabetic eye issues. This would lead to less gangrene, amputations, kidney failure and blindness, all of which are very expensive to treat. Do you see where I am going here?
There is information readily available these days. This can be good because anybody can research a topic and be informed. It can also be bad because people with incomplete knowledge can misinterpret this information. Information overload can be very confusing if one does not fully understand what it is one is reading and the implications, side effects and unintended consequences of the information obtained.
A good primary care physician can help you sift through the information and help answer questions about what is presented. He or she can help decide what is useful and what is not.
There are many conditions that do not really require a doctor’s intervention to treat. I will go into these in later chapters. Having this information can certainly help save time and money in copayments. Also, many things that a patient may go to an emergency room for are not truly emergencies and do not require that level of care. An emergency room visit may cost hundreds of dollars in copays and result in 8-12 hours of time spent waiting.
Many issues seen in an emergency room are much more appropriately taken care of in urgent care centers, which are much cheaper and faster. Many things taken care of at urgent care can best be taken care of at your doctor’s office where they have your medical records and know you.
So, in conclusion, this series is written to help better navigate the health care system, to keep you healthier and save you time and money on your healthcare. Stay tuned for my next chapter in this series: Health Insurance.